On the beautiful Kenyan coast, about halfway between 15th-century ruins and the vibrant city of Mombasa, a small factory is helping to achieve one of Africa's greatest healthcare goals: self-reliance.
With fewer than 700 employees, Revital Healthcare makes 300 million syringes per year, enough to meet more than half of Africa's routine immunization needs.
In the throes of the coronavirus pandemic, as governments faced having to vaccinate millions of people amid severe shortages, Revital shipped syringes to Sri Lanka, Sweden, the United Arab Emirates and Uzbekistan — and even sent 15 million syringes to India, Roneek said Vora, the company's director of sales and marketing.
“This is the first time ever in the life of Africa that a medical industry is exporting syringes to India, when we know that India is a major power in syringe manufacturing,” Mr Vora said. “This was a very big deal for us; it broke a lot of barriers,” he added.
Revital is lavishly funded through grants and contracts from many donor agencies, including the U.S. Agency for International Development, the Save the Children Foundation and multiple branches of the United Nations, and the company has lofty ambitions.
Many of Africa's attempts at medical self-reliance are hampered by limited financial resources, the lack of a robust regulatory system, and the challenges of transporting medicines and vaccines. Against that backdrop, Revital's success offers hope that an African company can produce essential products – not just for the continent, but also for export to other countries.
The company has a portfolio of 58 products, including rapid diagnostic test kits for various infectious diseases, medical tubing, face masks and a portable, electricity-free device that delivers oxygen to newborns. More than 200 of these devices were delivered to Ukraine in May 2022.
But the syringes in particular help meet a great need in Africa.
Countries in sub-Saharan Africa need 500 million shots every year just for routine vaccinations. And these countries are often hit by outbreaks that require mass vaccinations at short notice. Syringes are often the limiting factor.
“The world invests billions every year in the development and deployment of vaccines, but without a simple syringe that costs pennies, vaccines and the associated investments remain in the bottle,” said Surabhi Rajaram, program officer at the Bill & Melinda Gates Foundation. .
More than 80 percent of the syringes needed for vaccination are produced in Asia, Ms. Rajaram said. They are usually delivered by sea, which can delay arrival by months.
During the pandemic, India and China restricted exports of syringes, causing shortages and straining immunization programs in many countries, including some in Africa. “That was a place we never want to be again,” Ms. Rajaram said.
Revital's proximity to Mombasa's seaport and international airport, and to a road network connecting to landlocked countries in Africa, has reduced transportation times by 80 to 90 percent, she said.
With about $4 million in funding from the Gates Foundation, Revital is making so-called auto-shutoff syringes for early activation, which cannot be reused once the plunger is pushed into the barrel. Other syringes are not turned off until the plunger has been pushed all the way through the cylinder; this sometimes encourages doctors to stop before emptying and refilling a syringe, to preserve supplies. But this can contribute to the spread of HIV, hepatitis B and C and other diseases.
Revital is the only African company approved by the World Health Organization to produce early activation syringes.
Thanks to grants from global health organizations, the early activation syringes are to be sold in Africa. In addition, the Africa Centers for Disease Control and Prevention has set a goal of producing 60 percent of the needed vaccines by 2040.
“When we talk about vaccines, we talk about syringes, and we had no capacity to produce syringes,” said Dr. Jean Kaseya, the agency's director general. “Now we can cover at least 50 percent of our needs with Revital Healthcare.”
The company's ambitions extend far beyond spraying. When Covid arrived in Kenya in March 2020, “we didn't have surgical face masks, we didn't have vaccines, we didn't have syringes,” Mr Vora recalls. The company quickly increased production of face masks to 300,000 per day from 30,000, becoming the largest manufacturer of masks in sub-Saharan Africa.
Within six months, it increased production of syringes from 3 million per month to 30 million.
With $2.2 million from the U.S. Agency for International Development, Revital now aims to become Africa's largest manufacturer of rapid diagnostic test kits, producing about 20 million per month, and the company is hiring 200 workers to meet that demand. About half of the test kits would be for HIV, and the other half for malaria, hepatitis, dengue and other diseases. The factory open in May.
Revital is also the linchpin of a larger effort by Kenyan President William Ruto to produce health care kits for outbreaks. For example, in the event of a malaria outbreak, other companies can make rapid diagnostic tests, mosquito nets and antimalarials and vaccines; Revital would assemble the kits and ship them to outbreak zones.
The company was founded in 2008 with just 60 employees and is still family-run. Mr. Vora is a third-generation Kenyan of Indian descent. His uncle is the chairman of the company. His cousins manage the finances and operations. And Krupali Shah, who heads research and development, is a close family friend. Women make up about 80 percent of the workforce, exceeding the Gates Foundation's 50 percent goal.
Just minutes away from the spectacular beaches of Kilifi, the factory runs all day, every day, with employees working twelve-hour shifts. Much of the work is automated, but many workers spend hours in hot rooms with little air – because air conditioning units or fans can compromise sterility, Ms Shah said. Some machines emit piercing screams every few seconds. The workers were offered headphones but declined, a floor supervisor said.
Mr. Vora's great-grandmother was hearing-impaired and mute, and he said the company planned to employ more than 200 such women to assemble the syringes. The company has hired about 40 so far. On a warm day in December there were fewer than twenty.
At 60, hearing-impaired Truphosa Atieno is decades older than most other hearing-impaired workers. Ms. Atieno, a widow and single mother, was a primary school teacher, but when the pandemic closed the school, she “lived off hand” and sold honey, vegetables and sugar cane on the roadside, she said.
In November 2022, she was hit by a minivan and was unconscious for three days. She fractured her skull and elbow and suffered bruises to her ribs and fingers. Still, with four daughters aged 16 to 29, she wanted to work again, she says.
When she first worked at Revital, Ms Atieno lived in Jomvu, about 80 kilometers from Kilifi, and had to leave the house at 4am to be at work by 7am. She now shares a room in Kilifi with thirteen other women during the week, returning to Jomvu on weekends. What she earns “isn't enough,” she said, so she supplements her income by tutoring children on her days off.
Some other hearing-impaired women left the factory because the daily wage is about 600 Kenyan shillings per shift (less than $5) and their commute from Mombasa costs about half that.
Others could not cope with the daily quotas for productivity, or resented the ban on eating meat and eggs on site. (The Voras are strict vegetarians.)
“One of the problems is adapting to the culture here,” said Amina Mahmud, a project officer at a Mombasa-based nonprofit that placed the women, adding that the company’s “expectations are high.”